Key result
Percutaneous coronary intervention and coronary artery bypass grafting resulted in statistically equivalent rates of long-term mortality (10.2% vs 4.3%), myocardial infarction, stroke, and repeat revascularization in elderly patients with multi-vessel coronary artery disease.
Why the study?
Multi-vessel CAD is common in the elderly and presents a management difficulty, prompting comparison of long-term consequences of PCI versus CABG in this population.
Does percutaneous coronary intervention compared to coronary artery bypass graft surgery improve long-term major adverse cardiac events in elderly patients with multi-vessel coronary artery disease?
Cohort (n=100)
Yes
Does percutaneous coronary intervention compared to coronary artery bypass graft surgery improve long-term major adverse cardiac events in elderly patients with multi-vessel coronary artery disease?
Absolute Event Rate: 10.2% vs 4.3%
In elderly patients with multi-vessel CAD, PCI and CABG yielded statistically equivalent long-term rates of death, MI, stroke, and repeat revascularization, though CABG required a longer hospital stay.
Supports individualized revascularization choices in elderly multi-vessel disease; hypothesis-generating and requires randomized confirmation.
BACKGROUND: The most prevalent illness among the elderly is coronary artery disease (CAD), and most of this population present with multi-vessel CAD which constitutes a common management difficulty among elderly people. This study aimed to compare long-term consequences of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) revascularization in elderly patients with multi-vessel coronary artery disease. RESULTS: This retrospective study evaluated 100 elderly patients with multi-vessel CAD divided into two groups, group 1 the PCI group and group 2 the CABG group. The main findings of the study showed that CABG group had a longer hospital stay than the PCI group (8.16 vs. 2.02 days; P < 0.001). A considerably higher mean residual SYNTAX score was observed in the PCI group than CABG group which was 1.15 and 0.2, respectively (p-value < 0.001). The in-hospital major adverse cardiac events rate (MACE) in both groups was not statistically significant. Regarding the in-hospital mortality rate, although it was higher in the CABG group (6%) versus 2% in the PCI group, yet it was not statistically significant. The long-term MACE in this study revealed that 12.2% of PCI patients had heart failure compared to 6.4% in the CABG group, which was statistically insignificant. In the long-term follow-up, the revascularization rate of CABG group was higher than the PCI group; however, it was statistically insignificant. CABG group had a higher rate of stroke than PCI group being 4.3% and 2%, respectively; yet this difference was not statistically considerable. The long-term mortality rate among the PCI and CABG group was 10.2% and 4.3%, respectively. CONCLUSIONS: Elderly patients with multi-vessel CAD, PCI with stenting, and CABG were statistically equivalent in long-term death and MI rates, stroke, repeat revascularization. A non-statistically notable distinction between the two groups as regards MACE, composite of death or MI, and all-cause mortality was found. This may have implication on choice of management strategy among elderly patients with multi-vessel CAD.
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Kamal et al. (2022) conducted a cohort in Multi-vessel coronary artery disease (n=100). Percutaneous coronary intervention (PCI) vs. Coronary artery bypass grafting (CABG) was evaluated on Long-term mortality. Percutaneous coronary intervention and coronary artery bypass grafting resulted in statistically equivalent rates of long-term mortality (10.2% vs 4.3%), myocardial infarction, stroke, and repeat revascularization in elderly patients with multi-vessel coronary artery disease.
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